The Role of Media and Society in the Undercare of Menopausal Women

Did you know menopause as we understand it today is a relatively new phenomenon? As a speaker explained at a recent conference our team attended, it is only in the last century, starting in the early 1900s, that women consistently lived long enough to spend a significant portion of their lives in a post-menopausal state. Before that, many women didn’t live much past their reproductive years. Today, women often spend more than half their lives post-menopause.

Unfortunately, many of the discussions about menopause, and women’s health in general, remain astonishingly sparse and, sometimes, downright stuck in the last century. 

This lack of dialogue has profound consequences, not only when it comes to how women experience menopause, but also regarding how medical treatments such as hormone replacement therapy (HRT) are perceived and administered. For example, despite the scientific understanding that estrogen, or a combination of estrogen and progestin, is a safe and effective treatment for many women, there is a social narrative — one largely driven by media — that has complicated its use.

Increasing Awareness of Breast Cancer Risk Complicate HRT Evolution

The media’s skepticism of HRT, and whether it should be prescribed for women experiencing menopause, goes back at least a couple of generations.

About two decades after HRT was developed, in the 1980s, there was an increasing national focus on the risk of breast cancer. Indeed, the creation of National Breast Cancer Awareness Month in 1985 and First Lady Nancy Reagan’s mastectomy in 1987 catapulted breast cancer into the national spotlight. By the mid-1990s, many women believed breast cancer was the leading cause of death for women, despite heart disease being the actual primary killer. 

Several major national news stories also led women to believe that HRT significantly increased their breast cancer risk. 

This hyper-awareness of breast cancer, while undeniably important, inadvertently began to eclipse other health issues, particularly cardiovascular disease, and influenced how treatments like hormone replacement therapy were viewed. 

Compounding the Problem: The Women’s Health Initiative of 2002

In 2002, the Women’s Health Initiative (WHI) published findings that linked hormone replacement therapy to an increased risk of breast cancer, strokes, and blood clots. 

Now with what appeared to be evidence that HRT was associated with breast cancer, prescribing practices and patients’ interest in HRT changed with a swift and dramatic response. Within a matter of months, the number of women using HRT declined by nearly half. There is no doubt the WHI findings led to this abrupt shift in both patient and provider behavior. Women stopped HRT en masse, and healthcare providers, cautious of the risks, hesitated to recommend it. 

The problem was that the WHI failed to identify risk by age or scope of menopausal symptoms. The findings, for example, did not account for the fact that younger postmenopausal women may have different risks than older women, or that symptoms could guide treatment choices. The media, in its rush to communicate these findings, oversimplified the message: all hormone therapies for menopause should be avoided due to the risk of breast cancer. 

The WHI study did not occur in a vacuum. The cultural and societal backdrop of breast cancer awareness campaigns, coupled with the media’s role in simplifying complex medical findings, created an environment of fear and avoidance around HRT. Patients were left with incomplete information, and clinicians, wary of potential risks, shied away from offering HRT even when it was clinically appropriate.

Today we know the truth about HRT is much more complex.

Two Decades Later: A Balanced Approach to Hormone Replacement Therapy

If hormone replacement therapy was genuinely harmful to women’s health, one would have expected that the significant drop in its use would have led to measurable improvements in women’s health outcomes. Instead, observational studies have shown that while the use of HRT declined, rates of hormone-related cancers and chronic conditions did not decrease in a way that supports the notion of widespread harm from HRT. 

On the contrary, newer studies suggest the decrease in HRT use may have deprived many women of replacement therapy’s protective benefits, particularly when it comes to preventing heart disease and osteoporosis.

It is time for a more informed, balanced, and compassionate approach to menopausal care, one that prioritizes women’s health and well-being above all else. 

As such, modern menopause experts argue it is time to reconsider hormone replacement therapy. In fact, 22 years after the WHI study, new research has emerged suggesting HRT is safe for women under the age of 60. Moreover, today's replacement therapy options are different — delivered at lower doses with varying formulations — making them safer than ever before. 

The Path Forward: Empowering Women with Information and Options

As a society, we must do a better job of supporting women through all stages of their lives, including menopause.

The media has an undeniable influence on public health perceptions. Simplifying medical issues to soundbites may grab attention, but it can also do a disservice to the complexity of women’s health.

In the case of HRT, the media’s ability to amplify certain health risks contributed to a decade-long hesitation in treating menopausal symptoms effectively. Moving forward, it is crucial that media outlets, healthcare professionals, and public health campaigns collaborate to provide accurate, nuanced, and contextualized information. 

The conversation around menopause and hormone replacement therapy needs to shift. There is now a broader understanding of how and when HRT can be safely used. Women deserve access to this updated information to make informed decisions about their health, and clinicians need to feel empowered to offer HRT when it is appropriate without the lingering fear from two decades ago.